title: Risk factors for mortality in patients with Pseudomonas aeruginosa bacteremia: clinical impact of antimicrobial resistance on outcome.
abstract: Despite the high prevalence of antimicrobial resistance among Pseudomonas aeruginosa bacteremia, the clinical consequence of resistance remains unclear. The purpose of this study was to identify predictors of mortality and evaluate the clinical impact of antimicrobial resistance on outcome in P. aeruginosa bacteremia. A retrospective cohort study including patients with P. aeruginosa bacteremia was performed. The risk factors for antimicrobial resistances were evaluated, and the impact of the respective resistances on mortality was assessed. Of 202 P. aeruginosa bacteremia cases, the resistance rates to ceftazidime, piperacillin, imipenem, fluoroquinolone, and aminoglycoside were 36.6%, 22.3%, 22.8%, 23.8%, and 17.8%, respectively. A prior use of fluoroquinolones and an indwelling urinary catheter were common risk factors for all types of antimicrobial resistance. The overall 30-day mortality rate was 25.2% (51/202), and the risk factors for mortality were corticosteroid use, nosocomial acquisition, polymicrobial infection, an increasing Charlson's weighted co-morbidity index, and intensive care unit care (p < 0.05). As compared with the susceptible group, ceftazidime-, piperacillin-, or imipenem-resistant groups had a higher mortality (p < 0.05). A multivariate analysis showed that resistance to ceftazidime or imipenem remained a significant factor associated with mortality (odds ratio, 2.96; 95% confidential interval, 1.20-7.31; and odds ratio, 2.74; 95% confidential interval, 1.02-7.31, respectively). Antimicrobial resistance, especially to ceftazidime or imipenem, adversely affected outcome in patients with P. aeruginosa bacteremia.
authors.affiliation: Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Eun-Jeong
authors.initials: EJ
authors.lastname: Joo
authors.forename: Cheol-In
authors.initials: CI
authors.lastname: Kang
authors.forename: Young Eun
authors.initials: YE
authors.lastname: Ha
authors.forename: Seung-Ji
authors.initials: SJ
authors.lastname: Kang
authors.forename: So Yeon
authors.initials: SY
authors.lastname: Park
authors.forename: Doo Ryeon
authors.initials: DR
authors.lastname: Chung
authors.forename: Kyong Ran
authors.initials: KR
authors.lastname: Peck
authors.forename: Nam Yong
authors.initials: NY
authors.lastname: Lee
authors.forename: Jae-Hoon
authors.initials: JH
authors.lastname: Song
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D000617:Aminoglycosides / Q000494:pharmacology; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D057785:Catheters / Q000009:adverse effects; D002442:Ceftazidime / Q000494:pharmacology*; D003428:Cross Infection / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality*; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects; D005260:Female; D024841:Fluoroquinolones / Q000494:pharmacology; D006801:Humans; D015378:Imipenem / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D010878:Piperacillin / Q000494:pharmacology; D015995:Prevalence; D011552:Pseudomonas Infections / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality*; D011550:Pseudomonas aeruginosa / Q000187:drug effects* / Q000302:isolation & purification; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D015378:Imipenem; D002442:Ceftazidime; D010878:Piperacillin